Impact of Meaningful Use on EpiCenter

“What impact will meaningful use have on the EpiCenter application?  Has there been exploration to determine if the system will meet the criteria for meaningful use?”

— Julie, Kane County Illinois

EpiCenter is a syndromic surveillance system used by state and local public health departments.  The optional meaningful use criteria leaves it to public health to determine if and how syndromic surveillance is conducted in their region.

Certification applies to electronic health records (EHR).  There is a lot of discussion about this topic, as well as the process and meaning of certification.  There are multiple stages of certification that apply to EHRs and those stages align with the implementation of Meaningful Use criteria.

Since EpiCenter is not an EHR, the Certification Commission for Health Information Technology (CCHIT) certification process does not apply to it.

Hospitals Need to Understand Syndromic Surveillance

Hospitals are looking at the Meaningful Use criteria and wonder “What is really going on with this syndromic surveillance thing.”  For those of use who are engaged in the field, “biosurveillance” and “syndromic surveillance” are common terms.  For a lot of people in healthcare, however, these terms are very unfamiliar.  So, hospitals have some solid, basic questions about meeting the syndromic surveillance optional criteria.  Here is one example:

I am currently completing a Meaningful Use document and one of the Public Reporting options is the ability to send syndromic surveillance data to public health agencies.  I was wondering if you have any white paper on who sees the data and how the data we provide in this interface is utilized.  I appreciate your help.



Herminio S. Navia Jr. (Bebet)

Thanks to Bebet for the question and letting me post it here.  To answer your question, I’ll provide a general overview of syndromic surveillance, discuss our system specifically, and provide links to resources that would be useful for you.  Hopefully this can benefit any hospitals attempting to answer similar questions.



Syndromic surveillance is a type of disease surveillance that typically uses pre-diagnostic data to understand health trends in a region.  A primary goal of syndromic surveillance systems is to provide early event detection.

A typical syndromic surveillance system collects chief complaints or diagnoses from hospital emergency departments.  These data are then classified into syndrome categories and timeseries analysis performed on those categories in an effort to characterize health conditions.

Most surveillance systems will operate on limited data sets that contain only de-identified information.  Since the purpose of these systems is to understand regional trends and not specific cases, individual information is not needed.  Public health departments are very sensitive to maintaining patient privacy and prefer not to collect identifiable information unnecessarily.


Health Monitoring Systems provides the EpiCenter service to public health departments.  The EpiCenter service is operated on a Software-as-a-Service basis.  No software is installed at either the hospital or the health department. While EpiCenter is capable of receiving data via most any standard format, we typically receive registration data via a HL7 data feed.

Regardless of the method chosen, we require that data be transmitted securely to the EpiCenter system.  Once transmitted, the data is stored in our database cluster, classified into ‘syndromic’ categories, spatially tagged, and analyzed hourly to provide regional health trends.

Two types of users can access the data in the EpiCenter system.  Public health officials with authority over the region can see the data, as well as users from the facility providing the data.  (Facility users are restricted to see only data from their own facility.)

What do public health users do with the data and analysis from EpiCenter?  Lots of things:  disease outbreak detection, long-term studies of health trends, monitoring heat-related illness, identification of emergency department usage patterns, supporting efforts to identify tainted drugs, flu tracking & reporting — the list goes on.

Most system users will look at the data for their region daily, attempting to spot events of interest.  When something statistically interesting happens, EpiCenter will send a notification to public health of the event so they may follow-up on it specifically.


As for white papers discussing syndromic surveillance systems, the International Society for Disease Surveillance maintains a resources page.  This contains links to a wealth of information.

Other frequently referenced papers on the topic include this paper which is an early overview of implementing syndromic systems.   This paper also provides an overview of how various syndromic surveillance systems operate.

Published Final Rule (Federal Register)

The Centers for Medicare & Medicaid Services (CMS) published the Final Rule on July 28, 2009.  A PDF version of the Federal Register is available from Health Monitoring Systems website. –kjh

Final Rule

The Website HIPAA Survival Guide (aka HITECH Survival Guide) has resources for HIPAA compliance.  One nice posting includes a readable version of the final rule.  Digging through the Federal Register for the language is challenging.  This page presents the information in a nicely outline manner.  — kjh

§495.6 Meaningful use objectives and measures for EPs, eligible hospitals, and CAHs.

(a) Stage 1 criteria for EPs.

(1) General rule regarding Stage 1 criteria for meaningful use for EPs. Except as specified in paragraphs (a)(2) and (a)(3) of this section, EPs must meet all objectives and associated measures of the Stage 1 criteria specified in paragraph (d) of this section and five objectives of the EP‘s choice from paragraph (e) of this section to meet the definition of a meaningful EHR user.

(2) Exclusion for non-applicable objectives.

(i) An EP may exclude a particular objective contained in paragraphs (d) or (e) of this section, if the EP meets all of the following requirements:

(A) Must ensure that the objective in paragraph (d) or (e) of this section includes an option for the EP to attest that the objective is not applicable.

(B) Meets the criteria in the applicable objective that would permit the attestation.

(C) Attests.

(ii) An exclusion will reduce (by the number of exclusions applicable) the number of objectives that would otherwise apply. For example, an EP that has an exclusion from one of the objectives in paragraph (e) of this section must meet four (and not five) objectives of the EP‘s choice from such paragraph to meet the definition of a meaningful EHR user.

(3) Exception for Medicaid EPs who adopt, implement or upgrade in their first payment year. For Medicaid EPs who adopt, implement, or upgrade certified EHR technology in their first payment year, the meaningful use objectives and associated measures of the Stage 1 criteria specified in paragraphs (d) and (e) apply beginning with the second payment year, and do not apply to the first payment year.

(b) Stage 1 criteria for eligible hospitals and CAHs.

Read More Here…


Information for States on Meaningful Use

The Centers for Medicare & Medicaid Services have posted materials for states giving direction regarding what is necessary for meaningful use.  This information is not specific to public health, but it provides insight into the overall requirements.  Here is an article from their website that gives an introduction. — kjh

States may voluntarily offer the Medicaid EHR Incentive Program to their Medicaid eligible professionals and eligible hospitals. This page provides resources for states to understand the program and learn more about what is required to offer the programs.

Health IT Documents

To qualify to receive 90% federal matching funds for administering the Medicaid EHR Incentive Program, states must develop:

  • Health Information Technology Planning Advance Planning Document (HIT PAPD) – A plan of action that requests federal matching funds and approval to accomplish the planning necessary for a state agency to determine the need for and plan the acquisition of HIT equipment, services, or both.
  • State Medicaid Health Information Technology Plan (SMHP) – A document that describes the state’s current and future Health IT activities, as well as the path between, in support of the Medicaid EHR Incentive Program (see the SMHP template in the “Downloads” section below).
  • Health Information Technology Implementation Advance Planning Document (HIT IAPD) – A plan of action that requests federal matching funds and approval to acquire and implement the proposed SMHP services, equipment, or both.

The HIT PAPD, SMHP, and HIT IAPD lay out the process states will use to implement and oversee the Medicaid EHR Incentive Program. These documents help states construct a Health IT roadmap to develop the systems necessary to support providers in their adoption and meaningful use of certified EHR technology.

  • States are required to submit these documents in order for CMS to approve receipt of the 90% Federal match.
  • Prior approval is required for the HIT PAPD and HIT IAPD. The SMHP is the deliverable resulting from the HIT PAPD. The SMHP will be reviewed and approved before implementation funds are authorized under the IAPD. The APD and SMHP processes allow states to update their Advance Planning Documents and SMHP when they anticipate changes in scope, cost, schedule, etc. This allows states to add additional tasks to the contract which they may have not thought of at the time the HIT PAPD was written, as they worked through the original tasks on the original submission.

As states begin developing their SMHPs, they can also begin receiving the 90% federal matching funds to be used to support their initial Medicaid EHR Incentive Program planning activities, as long as the relevant Advance Planning Documents are approved. For example, initial planning regarding the design and development of the anticipated SMHP may be eligible for the 90% federal matching funds as an expense related to the administration of the Medicaid EHR incentive payments and, more broadly, for promoting health information exchange.  Read more here…

Welcome to the Blog!

In recent weeks, Health Monitoring Systems has been fielding a lot of questions regarding meaningful use from both hospitals and public health departments.  And, we have been doing a lot of digging, too.  While we aren’t the experts, we thought it would be useful to share the information we have and our views.

And so, we created this blog.

The purpose of the blog is to provide both resources and opinion regarding trends in healthcare related to healthcare data exchange (its what we do!).  Meaningful Use affects both of the HMS products MediCenter and EpiCenter.

EpiCenter collects and analyzes healthcare data, providing a view into regional health conditions for public health and healthcare.  MediCenter reverses the flow and provides patient medication history to clinicians at the point of care.  With all of the activity around meaningful use and health information exchange, it is safe to say we are heavily invested in this area.

Please participate by registering on the site and leaving comments.  We turned on registration, not to harvest email addresses but to prevent SPAM comments.

If you have some thoughts on these topics, please drop me a line at  We are actively seeking guest bloggers to provide their opinions and insights.

Once again, welcome to the blog.

— kjh

95% accuracy in 37 seconds


Health Monitoring Systems conducted a pilot study of the MediCenter medication reconciliation system that showed improved medication list accuracy, increased nursing efficiency, and demonstrated clinical significance while offering a potential return on investment of $300,000.

Pilot Study

Numerous healthcare quality organizations have identified medication administration as an area of improvement for patient safety. The Joint Commission has led the way with Patient Safety Goal #8, Medication Reconciliation. Although this quality initiative is of value to hospitals, implementation has been difficult.

The MediCenter service automates compilation of the patient’s home medication list by accessing prescription history from payers and pharmacies.

Are automated home medication lists effective in a clinical environment? A formal MediCenter study, conducted from January to March 2010 at a pilot hospital, demonstrated that they were. MediCenter improved medication list accuracy, increased nursing efficiency, and demonstrated clinical significance during the pilot period.

Improving Medication History Accuracy

The goal of compiling patient medication history is to avoid Adverse Drug Events (ADEs) and support diagnosis and treatment.

MediCenter achieves this goal. Nurses using MediCenter receive medication history for 75% of visits. For these patients, 95% of their current medications were correctly identified.

In contrast, a nurse following best practices and using a patient’s previous medication history from the hospital only identified about 70% of home medications.

When conducting a medication history interview with MediCenter, clinical staff members can uncover nearly 35% more medications for each patient, improving medication history accuracy.

Increasing Nursing Efficiency

The challenge facing the Joint Commission’s Patient Safety Goal #8 has been the inefficiency hospitals faced while implementing a thorough medication reconciliation process.

Anecdotal evidence describes 20, 30, and 40 minutes to compile medication history per patient. A 2008 survey conducted by Health Monitoring Systems of 40 hospitals indicated that the process could take 15 minutes.

Performing consistent medication history interviews at each entrance to a hospital has been identified as a best practice. Hospitals implementing this practice have struggled with a trade-off between efficiency and accuracy.

To achieve the same level of accuracy as with MediCenter, approximately 20 additional minutes of nursing time would need to be spent with each patient, following up with calls to family members, physician offices, and pharmacies.

As an additional confirmation of MediCenter’s utility, in-patient complied home medication history was compared against MediCenter results. The level of agreement between these two sources was comparable to what was observed with lists compiled in the ED and MediCenter.

Demonstrating Clinical Significance

MediCenter routinely provides an accurate medication history to clinicians efficiently, but are the results meaningful? 

When asked, physicians are clear.  Having knowledge of each and every medication is important.  It is equally clear that a trade-off is made, balancing time to gather data against the value it provides.  In general, all of the additional medications discovered with MediCenter are significant. 

Specifically, MediCenter identified NSAIDs, controlled narcotics, cardiac drugs, anti-depressants, and antibiotics at rates greater than the 35% average.  The following table illustrates the improvement in reporting when using MediCenter:


Reporting Improvement



Controlled Narcotics


Cardiac Drugs






Another concern are ADEs due interactions with commonly administered treatments.  Of the medications uncovered by MediCenter, 2 in 5 patients had an unreported medication that had a potential severe interaction with the most common treatments. 

MediCenter results demonstrate that significant categories of medications are underreported and that ADEs can be reduced establishing clinical significance.  



MediCenter’s straight-forward design makes it simple for hospitals to get going.  Our project management team has an easy-to-follow checklist of items for hospitals to review.  These items include operational aspects that ensure administrative, legal, and clinical issues are addressed. 

The IT implementation of the MediCenter service is straightforward as well.  In less than a week, Health Monitoring Systems’ team can have the MediCenter Web Reconciliation service working for you. 

To support successful incorporation of MediCenter into routine work processes, Health Monitoring Systems offers MediCenter as a distinct set of services.  These include:

  • Automated Medication History Service
  • Medication Reconciliation Service
  • Medication Sync Integration Service

With the Automated Medication History and Medication Reconciliation Services, hospitals can use MediCenter’s web-based interface to view and manage patient medication history.  This lowers the cost of deployment for hospitals and the bar of entry for facilities to begin automation of the medication reconciliation process.

The Medication Sync Integration Service provides a way to distribute information regarding medication history to other areas of the hospital, including pharmacy and inpatient admissions to ensure that the entire team has the information they need to provide the best care possible. 


In 2008, Health Monitoring Systems had connected its 300th hosptial to the EpiCenter System.  At the time, this was the largest health information exchange in the country. 

While explaining this milestone to Kimberly Lyons-Neel, a hospital executive, lightening struck.  Ms. Lyons-Neel immediately grasped the significance of Health Monitoring Systems’ large health information exchange.  “You know what would be really great?  If you could get information to the nurses about patients’ medication.  These new JCAHO requirements are really hard on nursing.”

With that conversation, MediCenter was born. 

MediCenter provides valuable health information at the point of care.  Here, where the information is needed most, it can positively affect clinical decision making and the quality of care.  By leveraging the infrastructure already established at Health Monitoring Systems, MediCenter is a demonstration of effective, affordable health information exchange. 

MediCenter represents a significant step forward in how healthcare thinks about health information exchange. 

Return on Investment

MediCenter improves medication list accuracy, increases nursing efficiency, and demonstrates clinical significance. The end result is an improvement in operating costs of about $300,000.

Improvement in operating costs is due to reductions in nursing time and adverse drug event rate.

Hospitals are inherently complex. As a reference, a 250 bed facility with 40,000 emergency department visits and 12,000 inpatient admissions would realize a savings of nearly $200K in nursing costs during the course of a year.

Similarly, the same facility should expect a reduction in the ADE rate. The Agency for Healthcare Research and Quality (AHRQ) reports that ADE rates range between 2 to 7 per 100 admissions. At the same time, the cost per ADE is estimated between $2,000 and $9,000.

By helping decrease missed dosages, duplicated therapy, and drug-drug interactions, MediCenter should help reduce the ADE rate by .2 per 100 admissions. Using a below-average ADE cost of $4,500, the facility should expect a savings of about $100,000 annually in ADE related expenses.

In total, the reference facility using MediCenter should realize $300,000 in operating savings per year while improving patient safety and the quality of healthcare delivery.